Negative Emotions in Chinese Frontline Medical Staff During the Early Stage of the COVID-19 Epidemic: Status, Trend, and Influential Pathways Based on a National Investigation

Psychopathology symptoms of frontline nurses under sudden public health crisis: A network analysis

Public health crises can significantly impact the emotional well-being of healthcare workers. Network analysis is a novel approach to exploring interactions between mental disorders at the symptom level. This study aimed to elucidate the characteristics of post-traumatic stress disorder (PTSD), anxiety, depression, and insomnia symptoms network among frontline nurses under sudden public health crisis. A cross-sectional survey was conducted online among 556 frontline nurses through convenience sampling in Hubei Province, China, from 21 February 2020, to 10 March 2020. Symptoms of PTSD, anxiety, depression, and insomnia were assessed by the Post-Traumatic Stress Disorder Checklist (PCL-5), Generalized Anxiety Disorder scale (GAD-7), Patient Health Questionnaire (PHQ-9) and Insomnia Severity Index, respectively. Central symptoms (the most important symptoms, activation has the strongest influence the other nodes) and bridge symptoms (nodes where deactivation can prevent activation from spreading from one disorder to another) were identified via centrality and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedure. We found that the correlation between PHQ-9 item 9 'suicidal thoughts' and PCL-5 item 16 'reckless or self-destructive behaviour' was the strongest. Moreover, 'reckless or self-destructive behaviour' was the strongest central symptom, and PHQ-9 item 3 'sleep problems' was the most important bridge symptom. Other major symptoms included GAD-7 item 6 'uncontrollable anxiety' and PHQ-9 item 2 'depressed or sad mood'. Timely, systemic targeting interventions on central symptoms and bridge symptoms may effectively alleviate co-occurring experiences of psychopathological symptoms among frontline nurses.

Lifestyle patterns influence the composition of the gut microbiome in a healthy Chinese population

High-throughput sequencing allows for the comprehensive analysis of the human intestinal microbiota. However, extensive association analyses between the microbiome and lifestyle differences in the Chinese population are limited. Here, we carried out an independent cohort study-the Chinese Healthy Gut Project (n = 483)-where correlations between the gut microbiota and dietary and lifestyle variables in a healthy Chinese population are defined. We collected both questionnaire data, including basic information and lifestyle and dietary variables, and fecal stools from the enrolled volunteers. We then performed 16S rRNA sequencing on the microbial DNA isolated from the stools to assess the composition of the intestinal microbiota. We found that Prevotella and Bacteroides were the most abundant genera in the healthy Chinese gut microbiome. Additionally, 9 out of 29 clinical and questionnaire-based phenotype covariates were found to be associated with the variation in the composition of the gut microbiota. Among these lifestyle phenotypes, sleep procrastination, negative mood, and drinking habits had the largest effect size. Additionally, an appreciable effect of urbanization was observed, resulting in decreased intra-individual diversity, increased inter-individual diversity, and an increased abundance of the Bacteroides enterotype. The results of this study provide a foundation for assessing the healthy Chinese gut microbiota community structure at baseline in a healthy Chinese population. Furthermore, this study also provides insights into understanding how distinctive living habits influence the relationships between the Chinese gut microbiome and systemic health state.

Stress overload, influencing factors, and psychological experiences of nurse managers during early stages of the COVID-19 pandemic: a sequential explanatory mixed method study

Background

Healthcare systems had an exceptionally difficult time during the early COVID-19 pandemic. Nurse managers in particular made enormous contributions to ensuring the safety of patients and front-line nurses while being under excessive psychological stress. However, little is known about their experiences during this time.

Objective

The aim of this study was thus to assess the level of stress overload and psychological feelings of nurse managers during the early COVID-19 pandemic.

Methods

A mixed methods sequential explanatory design study with non-random convenience sampling was performed, following the STROBE and COREQ checklists. The study was conducted at the Affiliated Dongyang Hospital, Wenzhou Medical University, with data collected from six provinces in southern China (Zhejiang, Hubei, Shanghai, Jiangsu, Hunan and Jiangxi) during March 2020 and June 2020. A total of 966 nurse managers completed the Stress Overload Scale and Work-Family Support Scale. In addition, a nested sample of nurse managers participated in semi-structured face-to-face interviews. The data were then analyzed using qualitative content analysis, Pearson correlation, and multiple linear regression.

Results

The quantitative results showed that nurse managers experienced a moderate level of stress load. There was a significant negative correlation between work-family support and stress load (r = -0.551, p < 0.01). Concerns about protecting front-line nurses and work-family support were the main factors affecting the stress load, which accounted for 34.0% of the total variation. Qualitative analysis identified four main thematic analyses that explained stress load: (1) great responsibility and great stress, (2) unprecedented stress-induced stress response, (3) invisible stress: the unknown was even more frightening, and (4) stress relief from love and support. Taken together these findings indicate that concern about protecting front-line nurses and negative work-family support of nurse managers were the main factors causing stress overload.

Conclusion

Implementing measures focused on individual psychological adjustment combined with community and family support and belongingness is one potential strategy to reduce psychological stress among nurse managers.

How nursing students' risk perception affected their professional commitment during the COVID-19 pandemic: the mediating effects of negative emotions and moderating effects of psychological capital

Nurses play a pivotal role in the delivery of medical services. Professional commitment is crucial for nursing professionals' long-term, healthy, and sustainable development. However, nursing students' professional commitment levels are currently unsatisfactory in China, especially given that the COVID-19 pandemic has posed unprecedented challenges to the profession. Therefore, studies investigating the professional commitment levels of nursing students and the underlying influencing factors are urgently required. This study explored how nursing students' risk perceptions, negative emotions, and psychological capital affected their professional commitment during the COVID-19 pandemic. A cross-sectional study was conducted among nursing students using risk perception, professional commitment, negative emotions, and psychological capital scales. An analysis of 1142 Chinese nursing students suggested that nursing students' risk perception positively impacted professional commitment and that negative emotions mediated this association. Importantly, psychological capital moderates the mediating effect of negative emotions and can buffer the negative emotions caused by risk perception. This study demonstrated that effective intervention strategies should be implemented in multiple dimensions such as education, individual, public and society to improve the professional commitment of nursing students.

How does centralized isolation treatment strategy affect the medical staff's mental health during the COVID-19 pandemic?

Background

During the coronavirus 2019 (COVID-19) pandemic, the Chinese Government adopted a centralized isolation treatment (CIT) strategy for patients, which has greatly improved the efficiency of the pandemic response. However, compared to those in local hospitals, anti-COVID-19 medical staff in mobile cabin hospitals, where the CIT strategy was adopted, suffered more mental health problems. This study aimed to explore how the CIT strategy affected the medical staff's mental health by comparing anti-COVID-19 medical staff who worked in mobile cabin hospitals to those in fever clinics of local hospitals.

Methods

Following the standard scale development procedure, this study first developed a scale measuring the mental health of anti-COVID-19 medical staff. Using SPSS 23.0 and Amos 23.0 software, the exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and reliability analysis method were conducted to support the scale development. In the main investigation, a survey method using the developed scale was used, and 839 anti-COVID-19 medical staff from five hospitals in northern China were recruited as participants by snowball-sampling method. The first survey was conducted in February 2020, when the first round of COVID-19 was at a serious time. In April 2020, after the first round of COVID-19 in China was initially contained, and medical staff who worked in mobile cabin hospitals returned to local hospitals, a follow-up survey was conducted on these participants. Using SPSS 23.0 software, a series of 2 × 2 mixed-design ANOVA was conducted, in which working conditions (mobile cabin hospital vs. local hospital) served as a between-subject factor, time points (during vs. after the first round of COVID-19) served as a within-subject variable, and the indicators of the medical staff's mental health served as dependent variables respectively.

Results

The reliability and validity of the developed scale were desirable. The mental health problems of anti-COVID-19 medical staff were mainly manifested as anxiety, powerlessness, fear of infection, and somatization. Compared to those who worked in local hospitals, anti-COVID-19 medical staff who worked in mobile cabin hospitals where the CIT strategy was adopted suffered more powerlessness, fear of infection, and somatization. After returning to local hospitals, symptoms of fear of infection and powerlessness of medical staff who used to work in mobile cabin hospitals decreased significantly. However, their anxiety symptoms were not relieved, and their somatization symptoms even increased.

Conclusion

This study implied that the mental health of anti-COVID-19 medical staff in mobile cabin hospitals adopting CIT was worse than in local hospitals. Moreover, with the first outbreak in remission, the mental health recovery of medical staff in CIT hospitals was slower than in local hospitals. Relevant practitioners should pay more attention to the mental health condition of anti-COVID-19 medical staff who work in CIT hospitals. The psychological assistance service for them should continue even after they return to the local hospitals.

Analysis of the mental health status of hospital staff during the COVID-19 pandemic

BACKGROUND

Medical work is a complex and interpersonally sensitive job; clinicians interact with patients, colleagues and society-at-large daily, and they are under pressure from a variety of sources. The doctor-patient relationship is of particular concern.

OBJECTIVE

To investigate the current mental health status of hospital staff and related influencing factors during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

The Symptom Checklist-90 (SCL-90) and Generalized Anxiety Disorder Scale-7 (GAD-7) were used to survey the current mental health status of hospital employees. The resulting qualitative data was described in the form of frequency and percentage (%), and the quantitative data were expressed as mean±standard deviation (X¯±S).

RESULTS

A total of 1,074 employees of The Third Xiangya Hospital of Central South University participated in the mental health survey, of whom 77.47% were women. The SCL-90 score was 133.89±48.87, and the three highest scoring factors were depression, somatisation and obsessions, with factor scores of 19.10±8.14, 16.78±6.21 and 16.27±6.39, respectively. The GAD-7 score was 3.74±4.17 for women and 2.14±3.55 for men. The number of women with anxiety disorders was higher compared with men.

CONCLUSION

The mental health status of hospital workers with different demographic characteristics varied greatly during the COVID-19 pandemic. Active attention needs to be paid to the mental health status of hospital staff.

The relations between emotion regulation, depression and anxiety among medical staff during the late stage of COVID-19 pandemic: a network analysis

Existing research proposed that moving from a disorder-level analysis to a symptom-level analysis may provide a more fine-grained understanding of psychopathology. This study aimed to explore the relations between two dimensions (i.e., cognitive reappraisal, CR; expressive suppression, ES) of emotion regulation and individual symptoms of depression and anxiety among medical staff during the late stage of COVID-19 pandemic. We examined depression symptoms, anxiety symptoms and emotion regulation among 420 medical staff during the late stage of COVID-19 pandemic via network analysis. Two networks (i.e. emotion regulation-depression network and emotion regulation-anxiety network) were constructed in the present study. Bridge centrality index was calculated for each variable within the two networks. Among the present sample, the prevalences of depression and anxiety are 39.5% and 26.0%. CR and ES showed distinct connections to symptoms of depression and anxiety. Results of bridge centrality showed that in both networks, CR had a negative bridge expected influence value while ES had a positive bridge expected influence value. The results revealed the specific role of CR and ES in relation to depression and anxiety at a symptom level. Implications for clinical preventions and interventions are discussed.

Experiences and needs of front-line nurses during the COVID-19 pandemic: A systematic review and qualitative meta-synthesis

Background

Front-line nurses have played a critical role during the coronavirus disease 2019 (COVID-19) pandemic. A number of qualitative studies reported front-line nurses' experiences and needs in caring for patients with COVID-19. However, the application of evidence from a single qualitative study to guide clinical practice has limitations. This study aimed to explore front-line nurses' experiences and needs during the COVID-19 pandemic through a qualitative meta-synthesis.

Methods

Seven databases were searched from 1 December 2019 to 20 January 2022, including PubMed, Web of Science, Cochrane COVID-19 study register, CINAHL, PsycINFO, MedRxiv, and bioRxiv. The quality of included studies was appraised using the Critical Appraisal Skills Program (CASP) qualitative research appraisal tool. Meta-synthesis was used to synthesize the data from included studies.

Results

A total of 70 studies were included, and five synthesized findings were developed: (1) Although nurses actively devoted themselves to fighting against COVID-19, considering their professional responsibility and historical previous experience with mankind, they were not invulnerable; (2) There were various difficulties and challenges in caring for patients with COVID-19, including fear related to providing patients with care, shortage of protective equipment and manpower, and negative attitude of family members; (3) Facing difficulties and challenges, nurses could only partly cope by using mixed means to overcome those, including media, learning, gaining skills, responding together, and organizational assistance; (4) To better respond to the COVID-19 pandemic, nurses' needs should be paid attention to. Counseling, training, information, resources, and investment are pivotal; (5) Despite the hardships, nurses became stronger and gained gratitude, positivity, mental peace, and confidence.

Conclusions

This study reveals that the psychological experiences of front-line nurses varied, and they faced a variety of challenges. Although nurses had some coping strategies, they still needed multifaceted support to meet the challenges.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, PROSPERO: CRD42021255468.